A 4-year-old girl is brought with 6 hours of repeated emesis, diffuse abdominal pain, and progressive lethargy after reportedly ingesting her grandmother's heart medication. Examination shows bradycardia (HR 44/min), BP 70/40 mmHg, and first-degree AV block on ECG. Which treatment is MOST specifically indicated?
- A Atropine 0.02 mg/kg IV
- B Digoxin-specific antibody fragments (Fab) ✓
- C Calcium gluconate 100 mg/kg IV
- D Sodium bicarbonate 1–2 mEq/kg IV
Explanation
The clinical picture of bradycardia, hypotension, GI symptoms, and AV block after ingestion of a cardiac medication in an elderly person strongly points to digoxin toxicity. Digoxin-specific antibody fragments (Fab; Digibind/DigiFab) are the antidote of choice for life-threatening digoxin poisoning in children and are the most specific treatment. Atropine may transiently help bradycardia but does not bind digoxin. Calcium gluconate is the antidote for calcium-channel blocker and beta-blocker toxicity but is relatively contraindicated in digoxin toxicity as it can worsen intracellular calcium overload. Sodium bicarbonate is used for sodium-channel blocker (e.g., tricyclic antidepressant) toxicity.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.